BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is exten...BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy.展开更多
Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the t...Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.展开更多
Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely un...Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important role.Due to the dynamic nature of the disease,its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population.Cigarette smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk factors.Many triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of CAVS.Provocative testing with direct visualization is currently the gold-standard for diagnosis,but non-invasive tests,including the use of biomarkers,are being increasingly studied to aid in the diagnosis.Treatment of the CAVS is an area of active research.Apart from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct role.High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further investigation.The role of pharmaceuticals targeting oxidative stress remains incompletely understood.展开更多
BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previ...BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram(EKG) findings;many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology;this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6,and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM.Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.展开更多
文摘BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy.
文摘Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.
文摘Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important role.Due to the dynamic nature of the disease,its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population.Cigarette smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk factors.Many triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of CAVS.Provocative testing with direct visualization is currently the gold-standard for diagnosis,but non-invasive tests,including the use of biomarkers,are being increasingly studied to aid in the diagnosis.Treatment of the CAVS is an area of active research.Apart from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct role.High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further investigation.The role of pharmaceuticals targeting oxidative stress remains incompletely understood.
文摘BACKGROUND Takotsubo cardiomyopathy(TCM) is a transient reversible systolic dysfunction,estimated to be the culprit in 1%-2% of patients presenting with clinical symptoms of acute coronary syndrome(ACS). TCM was previously thought to be indistinguishable from ACS on the basis of electrocardiogram(EKG) findings;many authors now describe specific EKG changes that distinguish TCM from ACS as well as aid in early recognition of TCM.CASE SUMMARY This unique case presentation illustrates an uncommon subtype of TCM, and very clearly exemplifies the specific EKG changes meant to aid in distinguishing TCM from ACS. A bronchogenic subtype of TCM has been proposed, given its prevalence and distinguishing features from TCM without pulmonary pathology;this case exemplifies that notion. The specific EKG changes of low QRS voltage and attenuation of the amplitude of the QRS complex are now being noted in the EKGs of TCM patients. This patient presented for worsening shortness of breath and increased productive cough; her EKG revealed ST elevations in leads V3-V6,and low voltage QRS complexes when compared to previous EKG from 12 wk ago; troponin peaked at 5.16 ng/mL. Left heart catheterization did not reveal significant lesions and left ventriculogram findings were consistent with TCM.Patient was treated for COPD exacerbation, her symptoms improved significantly; she was sent home on the appropriate medications.CONCLUSION This case exemplifies EKG changes noted in TCM patients who may aid in early detection and appropriate treatment of TCM.
